The financial burden of COVID-19 hospitalization: A retrospective economic evaluation

Wahyu Gito Putro

doi:10.70347/svsthya.v2i4.101

Authors

Wahyu Gito Putro Department of Community Medicine, Faculty of Medicine, Universitas Muhammadiyah Semarang https://orcid.org/0000-0001-9229-3194

DOI:

https://doi.org/10.70347/svsthya.v2i4.101

Keywords:

Cost of illness, COVID-19, health economics, healthcare cost, infectious disease, direct cost

Abstract

The COVID-19 pandemic continues to demonstrate dynamic fluctuations across global, regional, and local contexts. These ongoing variations have substantial public health and socioeconomic consequences worldwide. This study examines the financial and demographic effects of COVID-19 hospitalizations at South Tangerang General Hospital between 2021 and 2022. A retrospective economic analysis by comparing hospitalization data from 2021 and 2022. This study evaluated key parameters, including patient demographics, duration of hospitalization, treatment costs, and funding sources, identifying significant patterns across the study period. This study revealed notable changes in patient demographics, with the predominant age group shifting from > 59 years (2021) to 19-59 years (2022; p=0.000). The percentage of females represented increased from 49.1% to 59.5% (p=0.033). Compared with 2021 admissions, hospital stays were significantly shorter, with most 2022 patients discharged within 1–5 days (p=0.000). The average treatment costs declined from $3,676 to $2,024 (p=0.000), primarily due to reduced nursing and medication expenses. Funding sources transitioned from near-total (99.6%) reliance on the national COVID-19 program in 2021 to 52.7% coverage by the BPJS health insurance in 2022 (p=0.000). This study revealed significant changes in COVID-19 hospitalization patterns, characterized by younger patient populations, shorter hospital stays, and lower treatment costs. The evolving financial model, which incorporates both insurance and government support, highlights the necessity of forward-looking financial strategies in healthcare systems to effectively manage future health crises. These findings underscore the adaptive capacity of the healthcare sector and the critical role of socioeconomic considerations in treatment outcomes.

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Author Biography

Wahyu Gito Putro, Department of Community Medicine, Faculty of Medicine, Universitas Muhammadiyah Semarang

Department of Community Medicine, Faculty of Medicine, Universitas Muhammadiyah Semarang

References

Bedford J, Enria D, Giesecke J, Heymann DL, Ihekweazu C, Kobinger G, et al. COVID-19: toward controlling of a pandemic. Lancet 2020;395:1015–8. https://doi.org/10.1016/S0140-6736(20)30673-5.

Gautier JF, Ravussin Y. A new symptom of COVID-19: loss of taste and smell. Obesity 2020;28:848. https://doi.org/10.1002/oby.22809.

Alimohammadi M, Abolli S, Ghordouei Milan E. Perceiving effect of environmental factors on prevalence of sars-cov-2 virus and using health strategies: A review. J Adv Environ Health Res 2022;10:187–96. https://doi.org/10.32598/JAEHR.10.3.1266.

World Health Organization. COVID-19 Cases, World. 2025. Geneva: World Health Organization, 2025. https://data.who.int/dashboards/covid19/cases (accessed 13 January 2o25).

World Health Organization. COVID-19 epidemiological update. Geneva: World Health Organization, 2025. https://www.who.int/publications/m/item/covid-19-epidemiological-update-edition-177 (accessed 13 January 2o25).

Kementerian Kesehatan Republik Indonesia. COVID-19 Kembali Merebak di Luar Negeri, Masyarakat Diminta Waspada. Jakarta: 2025. https://indonesia.go.id/kategori/sosial-budaya/9383/covid-19-kembali-merebak-di-luar-negeri-masyarakat-indonesia-diminta-waspada?lang=1 (accessed 13 June 2o25).

Kementerian Kesehatan Republik Indonesia. Profil Kesehatan Indonesia tahun 2023. Jakarta: 2024. https://kemkes.go.id/id/profil-kesehatan-indonesia-2023 (accessed 13 January 2o25).

Kementerian Kesehatan Republik Indonesia. Profil Kesehatan Indonesia tahun 2020. Jakarta: 2021. https://kemkes.go.id/id/profil-kesehatan-indonesia-2020 (accessed 13 January 2o25).

Dinas Kesehatan Kota Tangerang Selatan. Profil Dinas Kesehatan Kota Tangerang Selatan Tahun 2023. Tangerang Selatan: 2024. https://dinkes.tangerangselatankota.go.id/storage/section/download/1_Profil%20Kesehatan%20Dinas%20Kesehatan%20Kota%20Tangerang%20Selatan%20Tahun%202023.pdf (accessed 13 January 2o25).

Jin H, Wang H, Li X, Zheng W, Ye S, Zhang S, et al. Economic burden of covid-19, China, January–march, 2020: A cost-of-illness study. Bull World Health Organ 2021;99:112–24. https://doi.org/10.2471/BLT.20.267112.

Bartsch SM, Ferguson MC, McKinnell JA, O’shea KJ, Wedlock PT, Siegmund SS, et al. The potential health care costs and resource use associated with COVID-19 in the United States. Health Aff 2020;39:927–35. https://doi.org/10.1377/hlthaff.2020.00426.

Juranek S, Paetzold J, Winner H, Zoutman FT, Zoutman F. Labor market effects of COVID-19 in Sweden and its neighbors. Kyklos (Oxford); 74(4):512-526. https://doi.org/10.1111/kykl.12282.

Park C-Y, Villafuerte J, Abiad A, Narayanan B, Banzon E, Samson J, et al. An updated assessment of the economic impact of COVID-19. Manila, Philippines: Asian Development Bank; 2020. https://doi.org/10.22617/BRF200144-2.

Southeast Asian Nation. Economic impact of COVID-19 outbreak on ASEAN. Jakarta: 2020. https://asean.org/wp-content/uploads/2021/09/ASEAN-Policy-Brief-April-2020_FINAL.pdf (accessed 13 January 2o25).

Haﬁdz F, Adiwibowo IR, Kusila GR, Ruby M, Saut B, Jaya C, et al. Out-of-pocket expenditure and catastrophic costs due to COVID-19 in Indonesia: A rapid online survey. Front Public Health 2023:1–8. https://doi.org/10.3389/fpubh.2023.1072250.

Direktorat Jenderal Perbendaharaan Provinsi Banten. Kajian Fiskal Regional Tahun 2021. 2021. https://djpb.kemenkeu.go.id/kanwil/banten/id/data-publikasi/artikel/2971-kajian-fiskal-regional-provinsi-banten-tahun-2021.html (accessed 13 January 2o25).

Badan Pusat Statistik Kota Tangerang Selatan. Produk Domestik Regional Bruto Kota Tangerang Selatan Menurut Lapangan Usaha 2016–2020. Tangerang Selatan: 2020. https://tangselkota.bps.go.id/id/publication/2021/04/05/0a7070f42cad2be0d03873f0/produk-domestik-regional-bruto-kota-tangerang-selatan-menurut-lapangan-usaha-2016-2020.html (accessed 13 January 2o25).

Fahmia R, Helda H, Nursari AY. Length of hospital stay for confirmed COVID-19 patients at the University of Indonesia Hospital and factors influencing it. J Epid Kesehat Indones 2022;6(1):5004. https://doi.org/10.7454/epidkes.v6i1.5004.

Firman F, Lestari K. Analysis of financing based on the length of stay of BPJS patients with type II diabetes mellitus and peripheral circulation complications at PKU Muhammadiyah General Hospital in Bantul. J Ekonom Kesehat Indones 2024;9:41–50. https://doi.org/10.7454/eki.v9i1.1119.

Richards F, Kodjamanova P, Chen X, Li N, Atanasov P, Bennetts L, et al. Economic burden of COVID-19: A systematic review. ClinicoEcon Outcomes Res 2022;14:293–307. https://doi.org/10.2147/CEOR.S338225.

Salsabillah M, Sabandi A, Gistituati N, Al Kadri H. Budaya organisasi sekolah menengah kejuruan [Eng: The culture of vocational high schools]. J High Educ Manag2022;1:29–34. https://doi.org/10.24036/johem.v1i1.

Sulung U, Muspawi M. Memahami sumber data penelitian: primer, sekunder, dan tersier [Eng: Understanding research data sources: primary, secondary, and tertiary]. J EdU Res 2024;5:110–6. https://doi.org/10.47827/jer.v5i3.238.

Heryana A. Pengolahan data penelitian: desain riset kuantitatif dan kualitatif 2024:1` – 12. https://doi.org/10.13140/RG.2.2.18673.29280.

Sarwono AE, Handayani A. Metode kuantitatif. 1st ed. Surakarta: UNISRI Press; 2021.

Nakhaee M, Khandehroo M, Esmaeili R. Cost of illness studies in COVID-19: a scoping review. Cost Eff Resour Alloc 2024;22:2–9. https://doi.org/10.1186/s12962-024-00514-7.

Azizah U, Akbar A. A comparative study of sales volume and revenue of electric bicycles on Shopee and Tokopedia. J Educ Develop 2024;12:258–68. https://doi.org/10.37081/ed.v12i1.5375.

Fauziyah N. Data analysis using Chi Square test in public health and clinical fields. 1st ed. Bandung: Politeknik Kesehatan Kemenkes Bandung; 2020.

Syafriani D, Darmana A, Syuhada FA, Sari DP. Statistical tests for educational research (methods and analysis using SPSS). 1st ed. Purbalingga: Eureka Media Aksara; 2023.

Starke KR, Reissig D, Petereit-Haack G, Schmauder S, Nienhaus A, Seidler A. The isolated effect of age on the risk of COVID-19 severe outcomes: A systematic review with meta-analysis. BMJ Glob Health 2021;6. https://doi.org/10.1136/bmjgh-2021-006434.

Peng Q, Ma X, Liu Z, Zhao C, Zhang L, Qian Z, et al. Differences in clinical characteristics between younger and older patients with COVID-19 and their relationship with the length of hospital stay. J Intensive Med 2021;1:123–9. https://doi.org/10.1016/j.jointm.2021.05.002.

Kementerian Kesehatan Republik Indonesia. Profil Kesehatan Indonesia Tahun 2021. Jakarta: 2022. https://kemkes.go.id/id/profil-kesehatan-indonesia-2021 (accessed 13 January 2o25).

Kementerian Kesehatan Republik Indonesia. Profil Kesehatan Indonesia Tahun 2022. Jakarta: 2023. https://kemkes.go.id/id/profil-kesehatan-indonesia-2022 (accessed 13 January 2o25).

Doerre A, Doblhammer G. The influence of gender on COVID-19 infections and mortality in Germany: Insights from age- and gender-specific modeling of contact rates, infections, and deaths in the early phase of the pandemic. PLoS One 2022;17:e0268119. https://doi.org/10.1371/journal.pone.0268119.

Rider F, Hauser WA, Yakovlev A, Shpak A, Guekht A. Incidence, severity and outcomes of COVID-19 in age and gender matched adults with and without epilepsy in Moscow: A historical cohort study. Seizure: Europ J Epilepsy 2023;112:32–9. https://doi.org/10.1016/j.seizure.2023.09.017.

Ancochea J, Izquierdo JL, Soriano JB, Lumbreras S. Evidence of gender differences in the diagnosis and management of coronavirus disease 2019 patients: An analysis of electronic health records using natural language processing and machine learning. J Womens Health 2021;30:393–404. https://doi.org/10.1089/jwh.2020.8721.

Zaher K, Basingab F, Alrahimi J, Basahel K, Aldahlawi A. Gender Differences in Response to COVID-19 Infection and Vaccination. Biomedicines 2023;11:1677. https://doi.org/10.3390/biomedicines11061677.

Korean Society of Infectious Diseases KS of PIDKS of EKS for ATKS for HIC and PKC for DC and Prevention. Report on the Epidemiological Features of Coronavirus Disease 2019 (COVID-19) Outbreak in the Republic of Korea from January 19 to March 2, 2020. J Korean Med Sci 2020; 35(10): e112. https://doi.org/10.3346/jkms.2020.35.e112.

Wu C, Qian Y. The gender peak effect: Women are most vulnerable to infections during COVID-19 peaks. Front Public Health 2022: 937179. https://doi.org/10.3389/fpubh.2022.937179.

Jin J, Wang W, Li A, Wu J. LMP7 inhibits the activation of NLRP3 inflammasome through interaction with NLRP3. Biochem Biophys Res Commun 2020;531:152–9. https://doi.org/10.1016/j.bbrc.2020.07.091.

Gemmati D, Bramanti B, Serino ML, Secchiero P, Zauli G, Tisato V. COVID-19 and individual genetic susceptibility/receptivity: Role of ACE1/ACE2 genes, immunity, inflammation and coagulation. might the double x-chromosome in females be protective against SARS-CoV-2 compared to the single x-chromosome in males? Int J Mol Sci 2020;21. https://doi.org/10.3390/ijms21103474.

Meng Y, Wu P, Lu W, Liu K, Ma K, Huang L, et al. Sex-specific clinical characteristics and prognosis of coronavirus disease-19 infection in Wuhan, China: A retrospective study of 168 severe patients. PLoS Pathog 2020;16. https://doi.org/10.1371/journal.ppat.1008520.

Mayerhöfer T, Klein SJ, Peer A, Perschinka F, Lehner GF, Hasslacher J, et al. Changes in characteristics and outcomes of critically ill COVID-19 patients in Tyrol (Austria) over 1 year. Wien Klin Wochenschr 2021;133:1237–47. https://doi.org/10.1007/s00508-021-01945-5.

Andayani N, Zahra Z, Malawati, Muhsin, Sungkar MH. Relationship between age, and gender with COVID- 19 treatment period for patients with mental disorders at the Aceh Mental Hospital in 2021. J Kedokteran Syah Kuala 2023;23:269–76. https://doi.org/10.24815/jks.v23i2.31252.

Widayati NS, Wihastuti TA, Yuliatun L, Kumboyono K. Factor contributing length of stay of COVID-19 patients in hospitals: scoping review. J Aisyah 2022;7. https://doi.org/10.30604/jika.v7i2.1160.

De Foo C, Verma M, Tan SY, Hamer J, van der Mark N, Pholpark A, et al. Health financing policies during the COVID-19 pandemic and implications for universal health care: a case study of 15 countries. Lancet Glob Health 2023;11:e1964–77. https://doi.org/10.1016/S2214-109X(23)00448-5.

Ndembi N, Dereje N, Nonvignon J, Aragaw M, Raji T, Fallah MP, et al. Financing pandemic prevention, preparedness and response: lessons learned and perspectives for future. Global Health 2024;20:65. https://doi.org/10.1186/s12992-024-01066-4.

Liu Y, Cui Q, Liu Y, Zhang J, Zhou M, Ali T, et al. Countermeasures against economic crisis from COVID-19 pandemic in China: An analysis of effectiveness and trade-offs. Struct Change Econ D 2021;59:482–95. https://doi.org/10.1016/j.strueco.2021.09.017.

Kim S, Koh K, Zhang X. Short-term impact of COVID-19 on consumption spending and its underlying mechanisms: Evidence from Singapore. Can J Econ 2022;55:115–34. https://doi.org/10.1111/caje.12538.

Karunayawong P, Gaewkhiew P, Sarajan MH, Boonma C, Butchon R, Sukmanee J, et al. High-cost users still came to hospitals during the COVID-19 pandemic during first wave data in Thailand: secondary data analysis. BMC Public Health 2024;24:2917. https://doi.org/10.1186/s12889-024-20325-y.

Mia S, Tabuñar S, Michelle T, Dominado P. Hospitalization expenditure of COVID-19 patients at the university of the Philippines-Philippine general hospital (UP-PGH) with PhilHealth Coverage. 2022. https://pesquisa.bvsalud.org/gim/resource/pt/wpr-876876

Kapinos KA, Peters RM, Murphy RE, Hohmann SF, Podichetty A, Greenberg RS. Inpatient Costs of Treating Patients With COVID-19. JAMA Netw Open 2024;7:e2350145. https://doi.org/10.1001/jamanetworkopen.2023.50145.

Yuan S, Li T, Chu C, Wang X, Liu L. Treatment cost assessment for COVID-19 inpatients in Shenzhen, China 2020–2021: facts and suggestions. Front Public Health 2023;11. https://doi.org/10.3389/fpubh.2023.1066694.

Reed A. What is the Average Salary in Indonesia? Livetecs 2024:1–4. https://www.bps.go.id/en/statistics-table/2/MTUyMSMy/average-of-net-wage- (accessed 21 June 2o25).